Reportedly, 300 million people worldwide are affected by the consumption of arsenic contaminated groundwater. India prominently figures amongst them and the state of Bihar has shown an upsurge in cases affected by arsenic poisoning. Escalated arsenic content in blood, leaves 1 in every 100 human being highly vulnerable to being affected by the disease. Uncontrolled intake may lead to skin, kidney, liver, bladder, or lung related cancer but even indirect forms of cancer are showing up on a regular basis with abnormal arsenic levels as the probable cause. But despite the apparent relation, the etiology has not been understood clearly. Blood samples of 2000 confirmed cancer patients were collected from pathology department of our institute. For cross-sectional design, 200 blood samples of subjects free from cancer from arsenic free pockets of Patna urban agglomeration, were collected. Blood arsenic levels in carcinoma patients as compared to sarcomas, lymphomas and leukemia were found to be higher. The geospatial map correlates the blood arsenic with cancer types and the demographic area of Gangetic plains. Most of the cancer patients with high blood arsenic concentration were from the districts near the river Ganges. The raised blood arsenic concentration in the 2000 cancer patients strongly correlates the relationship of arsenic with cancer especially the carcinoma type which is more vulnerable. The average arsenic concentration in blood of the cancer patients in the Gangetic plains denotes the significant role of arsenic which is present in endemic proportions. Thus, the study significantly correlates and advocates a strong relation of the deleterious element with the disease. It also underlines the need to address the problem by deciphering the root cause of the elevated cancer incidences in the Gangetic basin of Bihar and its association with arsenic poisoning.

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Globally, ~ 300 million people are exposed to arsenic poisoning while in India an estimated 70 million people are affected by consumption of arsenic contaminated water. The state of Bihar is an endemic belt for arsenic contamination in groundwater affecting over 10 million people with moderate to serious health manifestations. Life threatening disease like cancer is not uncommon now, and carcinoma type of cancer cases are on the rise. Breast cancer incidences in the state follows closely with more and more women getting affected. Approximately, 23% of the cancer types in women are related to breast cancer, diagnosed at a fairly advanced stage (III or IV) of the disease. The etiology of the disease is not clearly known though faulty lifestyle and genetic makeup cannot be ruled out. The present study attempts to derive a relation between increasing breast cancer cases with the sustained arsenic intake in the second most populated state of the country. Pathologically confirmed, female breast cancer patients (n = 55) from across the state were included in the study. Sampling of the breast tissue, blood, hair and toe nail was carried out by the surgical oncology department of the institute. As a part of cross-sectional study, (n = 12) female breast benign cases were taken as the control group and their biological samples were also collected. All the samples as per the protocol of NIOSH were digested and analysed by graphite furnace atomic absorption spectrophotometer. For the epidemiological parameter study, their age, type of malignancy, stage and demographic information was compiled. The results were correlated with the arsenic concentration in groundwater as per their endemic status and anomalous values on GIS platform. The role of geological studies to establish the morpho-stratigraphic control and aquifers with higher concentration was brought to use. The results are fairly indicative of the high correlation of anomalous concentration of arsenic with the sample population with diagnosed malignancy as compared to the control group. The maximum arsenic concentration observed in the biological samples in blood was 1856µg/L, in breast tissue 446.4µg/Kg, in hair 1296·9µg/Kg and in toenail 621·83µg/Kg respectively. The scattered plots correlate the relationship between age of the breast cancer patients with arsenic contamination, while the geospatial distribution positively correlates with the districts with increased arsenic endemicity in a predominantly alluvium dominated country. The high arsenic contamination in the biological samples of the breast cancer patients is an indicative marker to the possible relation of the disease to arsenic, as compared to the control population exposed to a much lesser toxicity. Consumption of water with more than 10 ppb arsenic contamination over a sustained longer time span has possibly exposed the population to a larger threat to disease as inferred from the findings. The disease breeding as a silent killer with reduced or unnoticeable symptoms upto a fairly advanced stage has further accentuated the problem. The present study thus endeavours to identify a significant relation of the disease with sustained intake of arsenic consumed through water and food products laden with anomalous concentration.

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In recent times Gallbladder cancer (GBC) incidences increased many folds in India and are being reported from arsenic hotspots identified in Bihar. The study aims to establish association between arsenic exposure and gallbladder carcinogenesis. In the present study, n = 200 were control volunteers and n = 152 confirmed gallbladder cancer cases. The studied GBC patient’s biological samples-gallbladder tissue, gallbladder stone, bile, blood and hair samples were collected for arsenic estimation. Moreover, n = 512 gallbladder cancer patients blood samples were also evaluated for the presence of arsenic to understand exposure level in the population. A significantly high arsenic concentration (p < 0.05) was detected in the blood samples with maximum concentration 389 µg/L in GBC cases in comparison to control. Similarly, in the gallbladder cancer patients, there was significantly high arsenic concentration observed in gallbladder tissue with highest concentration of 2166 µg/kg, in gallbladder stones 635 µg/kg, in bile samples 483 µg/L and in hair samples 6980 µg/kg respectively. Moreover, the n = 512 gallbladder cancer patient’s blood samples study revealed very significant arsenic concentration in the population of Bihar with maximum arsenic concentration as 746 µg/L. The raised arsenic concentration in the gallbladder cancer patients’ biological samples—gallbladder tissue, gallbladder stone, bile, blood, and hair samples was significantly very high in the arsenic exposed area. The study denotes that the gallbladder disease burden is very high in the arsenic exposed area of Bihar. The findings do provide a strong link between arsenic contamination and increased gallbladder carcinogenesis.